Big toe pain but too young for arthritis?…..
Most bones in the human body are connected to each other at joints. But there are a few bones that are not connected to any other bone. Instead, they are connected only to tendons or are embedded in muscle. These are the sesamoids. One of the very small sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the big toe.
Sesamoids act like pulleys. They provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. The sesamoids in the forefoot also assist with weight bearing and help elevate the bones of the great toe. Like other bones, sesamoids can break (fracture). Additionally, the tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis and is a form of tendinitis. It is common among ballet dancers, runners and baseball catchers.
- Pain is focused under the great toe on the ball of the foot. With sesamoiditis, pain may develop gradually; with a fracture, pain will be immediate.
- Swelling and bruising may or may not be present.
- You may experience difficulty and pain in bending and straightening the great toe.
During the examination, the physiotherapist will look for tenderness at the sesamoid bones. Your physio may manipulate the bone slightly or ask you to bend and straighten the toe. They might also bend the great toe up toward the top of the foot to see if the pain intensifies.
A request of an X-ray of the forefoot to ensure a proper diagnosis if a fracture is suspected. In many people, the sesamoid bone nearer the centre of the foot (the medial sesamoid) has two parts (bipartite). If the X-rays appear normal, then physiotherapy treatment should be undergone.
Treatment is generally non-operative. However, if conservative measures fail, then surgery may be recommended to remove the sesamoid bone.
Sesamoiditis – What you can do?
- Stop the activity causing the pain.
- Take aspirin or ibuprofen to relieve the pain.
- Rest and ice the sole of your feet. Do not apply ice directly to the skin, but use an ice pack or wrap the ice in a towel.
- Wear soft-soled, low-heeled shoes. Stiff-soled shoes like clogs may also be comfortable.
- Use a felt cushioning pad to relieve stress.
- Return to activity gradually, and continue to wear a cushioning pad of dense foam rubber under the sesamoids to support them. Avoid activities that put your weight on the balls of the feet.
- Tape the great toe so that it remains bent slightly downward (plantar flexion).
- Gentle joint mobilisation
- Friction massage to break up inflammation and scar tissue
- Home exercise programme to encourage continued improvement at home